| NPI | 1871718833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN R. TUCKER CEO 270-926-4107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 4475) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |